Is Percutaneous Adductor Tenotomy as Effective and Safe as the Open Procedure?

Hage, Samer El; Rachkidi, Rami El; Noun, Ziad; Haidar, Rachid; Dagher, Fernand; Kharrat, Khalil; Ghanem, Ismat

doi:10.1097/bpo.0b013e3181df619d

Cited by 31 publications

(22 citation statements)

References 17 publications

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“…Anatomical findings from this study are generally consistent with previous research. For example, dissection and surgical studies have also reported the proximal attachment of AL to be typically tendinous on its superficial surface in 90 to 100% of specimens (Tuite et al,1998; Strauss et al,2007; El Hage et al,2010). Secondary superior projections from AL to the distal rectus sheath, pubic symphysis, contralateral AL tendon, and ilio‐inguinal ligament concur with detailed early anatomical descriptions (Eisler,1912; Testut and Latarjet,1948) and more recent experimentally based investigations (Gibbon,1999; Robinson et al,2007; Davis et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath

et al. 2012

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The objectives of this study were to investigate the anatomical relationship between the proximal adductor longus (AL) and rectus abdominis muscles and to determine whether unilateral loading of AL results in strain transmission across the anterior pubic symphysis to the contralateral distal rectus sheath. Bilateral dissections were conducted on 10 embalmed cadavers. Strain transfer across the pubic symphysis was examined on seven of these cadavers. An AL contraction was simulated by applying a controlled load in the direction of its proximal tendinous fibers, and the resultant strain in the contralateral distal rectus sheath was measured using a foil-type surface mounted microstrain gage. Adductor longus attached to the antero-inferior aspect of the pubis. In 18 of the 20 limbs, the proximal attachment of AL was tendinous on its superficial surface and muscular on its deep surface. The proximal AL tendon was found in most instances to have secondary communications with structures such as the contralateral distal rectus sheath, pubic symphysis anterior capsule, ilio-inguinal ligament, and contralateral proximal AL tendon. Despite these consistent anatomical observations, strain measured in the contralateral distal rectus sheath upon unilateral loading of the proximal AL varied considerably between cadavers. Measured strain had an average ± 1SD of 0.23 ± 0.43%. The proximal attachment of AL contributes to an anatomical pathway across the anterior pubic symphysis that is likely required to withstand the transmission of large forces during multidirectional athletic activities. This anatomical relationship may be a relevant factor in explaining the apparent vulnerability of the AL and rectus abdominis attachments to injury.

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Section: Discussionmentioning

confidence: 99%

Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath

et al. 2012

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“…However, with the advent of percutaneous techniques, shorter procedural times and improved aesthetic outcomes became possible. Furthermore, there is evidence to suggest that percutaneous tenotomy is as safe and effective as the open procedure.It is notable that the extent of the tendinous portion divided in the muscle of interest appears directly correlated with increased postoperative mobility [54,55] . In animal studies, ultrasoundguided percutaneous tenotomy has been shown to increase complete tendon transection and decrease damage to surrounding structures compared to palpation-guided tenotomy (63).…”

Section: Percutaneous Tenotomymentioning

confidence: 97%

“…A brief listing of clinical indications and contraindications for percutaneous tenotomy are listed in Table 5. A comprehensive discussion of this topic is beyond the scope of this review [53][54][55][56][57][58][59][60][61][62][63] . Percutaneous tenotomy is ideally performed at the bedside or in an outpatient setting.…”

Section: Percutaneous Tenotomymentioning

confidence: 99%

Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature

Royall¹

2011

WJO

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Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.

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“…El Hage et al 53 , in Beirut, performed a prospective comparative study of twenty-seven patients (fifty hips) to determine if percutaneous adductor tenotomy was as safe and effective as an open tenotomy. In this unique study, a pediatric orthopaedic surgeon first performed a percutaneous adductor tenotomy, with a second surgeon then extending the wound to explore the percutaneous adductor tenotomy and to complete the tenotomy, if needed.…”

Section: Neuromuscular Diseasementioning

confidence: 99%